The ongoing fight over Big Pharma’s pricing policies continues as congressional leaders shift their focus to a drug that police departments use to treat heroin overdoses. While law enforcement agencies have become more accepting of this approach to combat drug abuse, recent price spikes put the future of city and state distribution programs in jeopardy.

Earlier this week, Sen. Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-MD) blasted Amphaster Pharmaceuticals, the maker of the drug naloxone, in a letter in which the duo questioned the rationale of increasing the price of the drug during a time when heroin overdose deaths have more than tripled within a three-year period.

“Over the past several months, police departments, law enforcement agencies, and public health officials across the country have warned about the increasing price of naloxone, which they use to combat the scourge of heroin abuse,” Sanders and Cummings wrote in their letter.

Naloxone, a generic drug that’s also known as Narcan, reverses the effects of potentially fatal opioid overdoses by relieving the depression of the nervous and respiratory systems and quelling symptoms of hypertension. Nearly half of U.S. states have passed laws granting wider access to naloxone, which can be administered in the bloodstream and through the nostrils. Doctors in those states can prescribe naloxone to friends and family members of opioid abusers. These measures also remove liability from people who dole out the drug, including police officers.

In April 2014, the Food and Drug Administration approved Evzio, a user-friendly naloxone injector to the satisfaction of public health officials and advocates. However, a sticker price of more than $400 keeps the tool out of the hands of many people who would prefer having the drug on hand in case a friend or family member overdoses. The price of the formula that can be injected nasally also doubled to the chagrin of law enforcement officials and heads of nonprofits, many of whom have turned to Amphaster — its sole producer — for answers.

“You’re being held at the whim of companies that can do what they want because they have a monopoly on a drug,” Eliza Wheeler, project manager for the Harm Reduction Coalition’s DOPE Program, told MedPage Today in November 2014. “The balance of our program rests on whether we can afford a product. That they can wantonly raise the price is terrifying.”

When it comes to naloxone, this type of price manipulation is nothing new. Pharmaceutical companies have adjusted prices of the drug according to its demand since it appeared on the market in the early 1970s. After the Centers for Disease Control and Prevention declared an opioid epidemic in 2008, for example, the price of the drug — which cost less than $3 per dose at the time — increased by more than $1,100 since then.

Today, law enforcement officers are reeling from naloxone price spikes of up toward 50 percent that threaten the potential to curb heroin addiction. Health officials in Maryland said they’re worried that the rising prices will stall their efforts to train police officers in doling out the drug to those experiencing an overdose. Long before Sanders and Cummings railed against Amphaster, Massachusetts Attorney General Maura Healey inquired about the increase in the price of naloxone amid a public health emergency in the state.

Ed Schneiderman, New York’s attorney general, took a similar approach and secured an agreement for $6 rebate per dose to agencies in the state for a year. Lawmakers, however, aren’t satisfied. In their letter, Sanders and Cummings called on Amphaster to make across-the-board price changes and subsidies similar to what was done for New York consumers, citing its potential to save lives.

“Although we are encouraged by your stated willingness to work with other states, it remains unclear why your company has not already lowered its prices in states other than New York. The rapid increase in the cost of this life-saving medication in such a short time frame is a significant public health concern,” the duo wrote.

Data from the Centers for Disease Control and Prevention supports their point: if made more readily, Naloxone could prevent more than 20,000 deaths in the United States annually. A 2013 study found that distributing the drug could save one life for every 227 kits that are distributed. Empirical evidence has also played a part in authorities’ change of heart. For example, more than 100,000 overdose reversals were reported from 188 naloxone distribution programs in the United States. In these programs, more than 53,000 people had been trained to administer the drug.

That’s why more people want to see community groups get access to the drug during a critical juncture in the fight against heroin abuse. One criticism has been that of the monopoly that pharmaceutical companies have on these products. Years before naloxone’s price exploded, advocates suggested taking the new approach a step further by distributing naloxone over the counter, predicting that failing to do so would further marginalize heroin addicts.

Even though widespread distribution in this manner doesn’t seem likely to happen, discussions about taking the life-saving medicine out of Big Pharma’s hands still occur. The editorial board of The Herald News, for example, suggested that pharmaceutical companies in Massachusetts develop a drug-delivery device that could compete with Naloxone toward the end of last year.

In a twist of irony, John Santilli of Access Market Intelligence, an organization that works with Big Pharma, had similar thoughts about the drawbacks that Amphaster’s stranglehold on naloxone could have for heroin addicts and their families.

“The increase in price of nasal naloxone from the lone manufacturer is having a large negative impact on the ability of community groups to pay for the drug,” Santilli told the Modern Medicine Network last year. “The price of a new auto-injector naloxone is projected to also be expensive. To keep naloxone affordable, it should not be burdened with regulatory obstacles and made available at a price similar to what it costs to produce,” Santilli added.

]]>After Measles Sweeps The Country, States Scramble To Make It Harder To Skip Vaccineshttp://thinkprogress.org/health/2015/03/03/3628844/state-vaccination-bills-proposed/
Tue, 03 Mar 2015 15:47:23 +0000Tara Culp-Resslerhttp://thinkprogress.org/default/2015/03/03/3628844//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2014/06/shutterstock_110218256-321x214.jpgThe measles outbreak isn't making national headlines anymore -- but it could have a lasting impact on state policy.

At least 10 states have proposed tightening their vaccine requirements to make it harder for parents to opt out their children from recommended shots, according to Reuters. It’s an issue that cuts across party lines; Reuters reports that most of this year’s measures have received bipartisan support and have a good chance of advancing.

At the beginning of the year, several politicians sparked controversy by suggesting that vaccinating children should be left up to parents’ discretion. “While I think it’s a good idea to take the vaccine, I think that’s a personal decision for individuals,” Sen. Rand Paul (R-KY) said last month, calling vaccination a matter of “freedom.”

Health experts disagree, maintaining that it’s important for all children to follow the current vaccination schedule, which is carefully timed to ensure the maximum amount of protection from potentially dangerous infectious diseases. This policy is largely enforced through the public school system. In all 50 states, there is some type of vaccination requirement for children entering public schools.

But many states also allow parents to circumvent those requirements by seeking a “personal belief” exemption, often requiring them to simply sign a form saying they’re personally opposed to vaccines — a loophole that’s been directly tied to lower rates of vaccination and higher rates of disease outbreaks.

“There seems to be more support for tightening up these nonmedical exemptions,” Diane Peterson, the associate director for immunization projects at the Immunization Action Coalition, told the National Law Journal last month, when states started scrambling to propose new bills in this area.

This type of legislation isn’t necessarily controversial on a broad scale. Recent polling conducted amid this year’s measles outbreak confirms that the majority of Americans favor mandating vaccines for children.

But the national conversation about infectious disease prevention has reinvigorated a small but vocal contingent of people who believe that vaccines can be harmful, and want to fight for their right to refuse the shots for their own families. Plus, while some parents may not reject vaccines altogether, they’re still skeptical of the immunization schedule recommended by the Centers for Disease Control and Prevention. One recent study found that more than 90 percent of pediatricians have received a request to forgo the federal schedule and delay kids’ vaccines.

That’s why, in addition to tighter state laws, some vaccine proponents are pushing for more education campaigns to help doctors learn how to be firmer with their parents in this area. Dr. Paul Offit, one of the country’s most prominent immunization experts, hosts lectures where he teaches physicians to calmly argue down parents who may question the use of vaccines during their next visit. Previous studies have also found that anti-vaccine parents are more likely to be swayed by talking to people in their social network versus hearing public health information from the government.

On Wednesday, the Supreme Court will hear oral arguments in a case that represents the first major challenge to the health reform law since the justices upheld its individual mandate in 2012. If the plaintiffs in King v. Burwell are successful, the government will no longer be allowed to offer subsidies to help Americans buy insurance in the states with federally-run marketplaces.

What does that mean in practical terms, and who exactly will be affected by the court’s decision? If the justices rule against Obamacare, here’s what you need to know:

34 states will be left scrambling to figure out what to do next.

The majority of states across the country have resisted fully implementing Obamacare, refusing to accept the law’s optional Medicaid expansion or build an insurance marketplace on their own. That’s left 34 states with marketplaces that are either fully or partially operated by the federal government — leaving them vulnerable to massive fall-out if the court rules that they can no longer offer subsidized insurance to their residents. There’s no clear plan about what to do in those states if the Obama administration loses its case.

13 million Americans will lose access to health insurance subsidies.

Among the people who bought insurance through Obamacare’s new marketplaces, the vast majority — about 87 percent, according to government data from the first round of open enrollment — are eligible for some type of financial assistance to help them afford their plan. But if the court rules against Obamacare, and they live in one of the 34 states with federally-run marketplaces, that assistance will disappear. Researchers at the Kaiser Family Foundation project that about 13.4 million people could lose their tax subsidies — with the highest numbers of affected people concentrated in red states that already have high rates of uninsurance, like Texas and Florida.

Premiums could increase between 122 percent and 774 percent.

Without the federal subsidies that make monthly premiums more affordable, the price tag for insurance plans in states with federally-run marketplaces could skyrocket from anywhere between 122 percent and 774 percent, according to a recent analysis from consulting firm Avalere Health. Avalere found that all 34 states will see an average spike of 255 percent. Data from the Department of Health and Human Services suggests a similar outcome; consumers who receive a tax credit would face an average 322 percent premium hike if they lost that credit, according to reports from last fall. In dollar signs, that’s a monthly increase ranging from $82 to $346, depending on the state. Insurance actuaries have already written to the federal government asking for permission to raise their rates if the court ends up gutting Obamacare.

8 million more Americans will go uninsured.

Dramatically higher premiums would make insurance simply unaffordable for most of the Americans who currently rely on Obamacare’s tax subsidies. Millions of people would likely immediately drop their plans, sending the insurance market into what experts refer to as a “market death spiral.” Insurance companies would be forced to raise their prices by another 47 percent to stay afloat, according to an analysis from the Rand Corporation. By those researchers’ estimations, that would leave about eight million people without any access to affordable insurance whatsoever. A different analysis from the Urban Institute and the Robert Wood Johnson Foundation concurred that about 8.2 million additional people will be uninsured if the King plaintiffs prevail.

71 percent of people will disagree with the ruling.

A recent poll conducted by Hart Research Associates finds that the majority of Americans are opposed to the idea that subsidies should be limited to the 16 states that run their own marketplaces. That poll, which was conducted in the middle of February on behalf of the Service Employees International Union (SEIU), found that respondents were opposed to the arguments behind King v. Burwell even though many of them favored reforming or repealing Obamacare. Seventy-one percent of people said that tax subsidies should be available to Americans in all 50 states, and 56 percent said they would “strongly prefer” the justices to rule in favor of this outcome.

Preventing suicide is a difficult undertaking because it’s an action that’s carried out swiftly and desperately by those struggling to deal with their mental anguish alone, even if they may lead a seemingly normal life. However, not all cries for help are silent — especially on social media, where you may come across melancholic statuses from friends on your newsfeed.

Now, Facebook wants to capitalize on the confessional nature of its platform. The social media giant is rolling out a new suicide prevention tool — which it created in partnership with a few mental health organizations — that allows users to reach out to their troubled loved ones virtually and connect them with online resources after spotting the first sign of trouble.

While mental health experts believe that the app could better help concerned family and friends spark much needed conversations and connect distressed people with resources, some warn against overly depending on the social media platform for help with these sensitive matters when direct contact may prove more effective.

With the suicide prevention app, users who are concerned about a friend’s post can directly “report” it by contacting their friend, another friend for support, or a suicide prevention hotline. Facebook then examines the reported post to see if warrants intervention. If so, the friend in question will receive a message that gives him or her the option of reaching out to a friend, calling a suicide hotline, or looking over a host of suicide prevention materials, including video messages and relaxation techniques.

“For those who may need help, we have significantly expanded the support and resources that are available to them the next time they log on to Facebook after we review a report of something they’ve posted,” Rob Boyle, Facebook’s product manager, and Nicole Staubli, Facebook’s community operations safety specialist, wrote in a statement posted on the social network last week during its Compassion Research Day, an annual event that’s part of an effort to help users flag potentially harmful material they see online.

As of last week, half of Facebook users worldwide received the suicide prevention app. All of those with a Facebook account will have access within a matter of months. Experts in the field are optimistic about the potential of the new tool.

“I’m really excited about this great news,” Lauren Redding, communications coordinator at Active Minds, a nonprofit organization that raises awareness about the issue among college students, told ThinkProgress. At Active Minds, Redding helps spread information about self-help resources to college students via social media. She said that Facebook’s suicide prevention app represents the successful integration of technology and mental health.

“This app is reaching people where they are,” Redding said. “We didn’t get this kind of mental health education 40 years ago. Members of the general public are getting information delivered to them on the social media platform. Facebook is our biggest tool in getting the message out about suicide prevention. Many mental health organizations and nonprofit are harnessing Facebook’s power to get information out to the masses.”

In recent years, social media has been construed as more of a culprit in the suicide epidemic among young people, particularly because of its potential to facilitate cyberbullying. However, people in the mental health and technology fields have increasingly realized that the platform could also serve as a tool in preventing suicides.

Researchers have found that while people who commit suicide aren’t likely to overtly outline their specific plans via social media, they may take to the online platform to describe themselves as a burden on the world and publicly ponder how they should “correct their mistakes.”

Lisa Horowitz, staff scientist and pediatric psychologist at the National Institute of Mental Health, praised Facebook’s latest strategy to meet troubled youngsters on a medium they use often, saying that the suicide prevention app enables friends and family members to step in immediately.

“We need to be thinking innovatively with our techniques and reach to a generation of people who are engaged on social media,” Horowitz told ThinkProgress. “People who are feeling suicidal also feel alienated and if they’re reaching out on social media, then it can be a bridge that helps them obtain really good prevention resources. Sometimes people don’t know what to say to their loved one and this tool gives them some language. It’s really hard to reach out to that you’ve noticed something about them that would require mental health attention.”

Mental health experts say that reaching out to a potentially suicidal person and connecting them with resources often requires family members to be empathetic, even if that means moving at the pace that’s slower than what they had in mind. Help Guide, an online repository of information about mental health issues, warns concerned friends and family against arguing with a troubled person and chastising them for wrangling with the thought of suicide. The quintessential interaction requires that one show no judgment, exhibit patience, reassure the person that everything will be okay, and directly asking the person in question if having suicidal thoughts.

Dr. Dan Reidenberg, executive director of Suicide Awareness Voices of Education, a suicide awareness organization, told ThinkProgress that while social media could never replace face-to-face contact, Facebook’s suicide prevention tool takes on some of the aforementioned methods by asking questions to potentially suicidal people and suggesting that they use resources rather than giving them a prescription. That aspect of the app, he said, places the onus on the troubled Facebook user while putting their friends and family’s minds at ease.

“We can’t overreact when someone is expressing the thoughts of suicide and self-harm,” Reidenberg said. “In some ways, this is that middle point where someone might be concerned and the user will be in the best position to determine with kind of help need. We continue to do all we can to do for them when they are ready for it… This tool helps because it has reminders in it. It helps troubled people do things on their own. When that’s not enough, it gives them the tools to know where to go next.”

Facebook’s suicide prevention app follows an attempt in 2011 to connect users to suicide prevention resources. Other companies have followed suit, including the Durkheim Project, which sought to analyze the speech patterns of potentially suicidal people. Google also stepped into the suicide prevention sphere in 2010 when the search engine launched a feature that directed any queries about suicide to contact information for the National Suicide Prevention Hotline.

But privacy, or a lack thereof, remains a concern among Facebook users. Only five percent of Americans trust the social network to protect their personal information, according to a poll conducted by the Princeton Survey Research Associates International in 2014. In the same poll, more than a quarter of respondents said they think Facebook would violate their privacy. Users may be turned off by the new app if their routine posts are being misidentified as a potential cry for help.

In an email to ThinkProgress, Ursula Whiteside, a researcher who helped launch Facebook’s suicide prevention app, acknowledged that some messages could get misinterpreted as warnings of a suicide attempt, but noted that Facebook will take steps to mitigate that. Its staff will be trained by the National Suicide Prevention Hotline and carefully review the material.

Even if some posts do get misreported, Pamela Rutledge, the director of the Media Psychology Research Center at Fielding Graduate University in Santa Barbara, CA, said that the Facebook suicide prevention app is a step in the right direction. It helps stress the need for people to be vigilant against signs of the trouble in the loved ones, especially if they haven’t spoken to them in some time or live in a different part of the country.

“What we’re seeing here is a shift toward making society more responsible for a citizen’s wellbeing. People are looking at these social networks in a way that when something bad happens, they’re looking at those who probably should have stepped in,” Rutledge said. “If you’re talking about something that could be harmful, then there’s a professional obligation on the part of Facebook to create a system where they can take steps. It’s just like in school; if a teacher as a reason to believe that a child is being abused, then they have a duty to report.”

But Horowitz pointed out that simply reporting the message to Facebook may not suffice. While she called the Facebook’s suicide app an effective tool in helping families overcome their fears about asking a loved one about their troubles, Horowitz said that old fashion face-to-face communication can still help all parties involved, especially the potentially suicidal person.

“If you’re worried that someone’s at risk for suicide, you should ask them directly,” Horowitz said. “People are afraid of asking someone that question because they’re worried about putting ideas in their head but that’s a myth. What you could do instead is ask someone about their plans. If they said they were going to kill themselves, that’s the time to ask the question.”

]]>More Than 100 Economists Pressure Vermont To Implement Universal Health Carehttp://thinkprogress.org/health/2015/03/02/3628413/economists-vermont-health-care/
Mon, 02 Mar 2015 14:34:26 +0000Tara Culp-Resslerhttp://thinkprogress.org/default/2015/03/02/3628413//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2014/07/health-care-human-right-3-321x214.jpgVermont's governor said a single-payer system will be too expensive, but a group of economic experts disagrees.

More than 100 economic experts are throwing their weight behind Vermont’s ambitious plans to build a universal health care system — a policy that was put on hold at the end of last year, after Gov. Peter Shumlin (D) said he wasn’t sure how the state could pay for it.

Over the past several years, Vermont has been working on building the first single-payer system in the country, a health care model under which all medically necessary services would be covered by the government. State officials have been dedicated to the reforms because the legislature approved a measure, called Act 48, that required Vermont to implement a single-payer system by 2017.

Supporters hoped that Vermont might prove that universal health care is possible in the United States, potentially inspiring other states to work on similar reforms. But progress stalled last December, when Shumlin announced that that “this is not the right time” to move forward with the state’s proposal, saying it would cost Vermont an estimated $3 billion per year by the end of the decade.

Now, economic professors from across the country are taking issue with the financial arguments against single-payer reform, saying that a government-funded system is “not only economically feasible but highly preferable to a fragmented market-based insurance system.”

In an open letter delivered to Shumlin and the state legislature, the economists argue that health care should be a service that’s provided as a public good, rather than a service that is left up to the whims of the private market. They write that financing health care is actually a more efficient way for governments to ensure their citizens are healthy, which saves money in the long run.

“Evidence from around the world demonstrates that publicly financed health care systems result in improved health outcomes, lower costs and greater equity,” the open letter states. “Public financing is not a matter of raising new money, but of distributing existing payments more equitably and efficiently.”

Shumlin, who only narrowly won re-election last fall, said the liberal state needed to put its single-payer reforms on hold because they will cost more money than initially projected. When he announced he was pausing the plan in December, he said the program would have required businesses to take on a 11.5 percent payroll tax and raised income taxes on individuals by up to 9.5 percent. “Risk of economic shock is too high at this time to offer a plan that I can responsibly support for passage in the Legislature,” the governor said.

Proponents of universal health care predicted that the close election would make it more difficult for the embattled governor to push forward with the ambitious single-payer plan. Activists in the state weren’t pleased when that turned out to be true. After Shumlin abandoned Act 48, Vermont residents gathered at the state house to burn their medical bills, saying that Shumlin’s decision was “a slap in the face of many thousands of Vermont residents who suffer from poor health and financial hardship.”

Other economic leaders have also argued in favor of the long-term benefits of universal health care. Two years ago, the president of the World Bank argued that every country should be working to implement full coverage by 2030, saying it’s an investment that actually ends up spurring growth and development.

The professors’ open letter comes on the heels of a new report released by the Vermont Workers’ Center and the National Economic and Social Rights Initiative in favor of single-payer reforms. Those two groups argue that universal health care can be implemented affordably in Vermont by taxing wealthy residents’ investment income and implementing a graduated payroll tax.

]]>The Battle Over A Brain-Dead Pregnant Woman’s Body Transformed Her Family Into Political Activistshttp://thinkprogress.org/health/2015/03/02/3627655/marlise-munoz-documentary/
Mon, 02 Mar 2015 13:00:58 +0000Tara Culp-Resslerhttp://thinkprogress.org/default/2015/02/26/3627655//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2015/02/AP288776087298-321x214.jpgHow the battle over Marlise Muñoz's body inspired her family to keep fighting.

National media may have moved on from last year’s battle over whether Marlise Muñoz, known in headlines as the “brain-dead pregnant woman,” was allowed to be released from life support in Texas last year — but her family hasn’t. In a new documentary, they’ll have a chance to talk about their journey from grieving loved ones to political activists, as well as the complex issues animating their cause.

Tentatively titled The Pregnancy Exclusion, the forthcoming documentary has been filming over the past year in the hopes of giving the family a different and more expansive kind of platform.

“After January, when Marlise had been taken off life support, it was suddenly like — poof! — the story was over. But they felt like they had been through the wringer and their story was not over,” director Rebecca Haimowitz told ThinkProgress. “It’s a story that deserved to be given more attention, and shown in a way that delves into all the complexities of the issue and really humanizes it.” Haimowitz is currently working on raising money for the film’s production costs.

It’s no wonder the story captured national attention at the time. The Muñoz family waited two months before they could bury Marlise’s body, an act of closure that was denied to them because Marlise was pregnant when she died. After she suffered a massive blood clot and was pronounced brain dead, the hospital refused to take her off the respirator — citing an obscure state law that stipulates Texas may not remove “life-sustaining treatment” from a pregnant woman, even if that goes against her end-of-life wishes. Although Marlise was legally deceased, officials wanted to keep her hooked up to machines until the fetus that she was carrying could be delivered.

The family’s saga went on for weeks, as Marlise’s husband and parents told the press how painful it was to watch her body slowly decompose as she remained breathing with the help of a ventilator. Eventually, a federal judge ruled in the Muñozes’ favor, determining that the hospital could not apply the law in this situation because Marlise was already dead. One year later, however, the controversy over the rights of pregnant women is being renewed.

Just last week, a Texas lawmaker introduced a bill in direct response to the Muñoz case that would appoint legal representation for fetuses in future disputes over whether pregnant women should remain hooked up to life support. The sponsor of that bill, Rep. Matt Krause (R), says his proposal will “give the pre-born child a chance to have a voice in court.” If the measure advances to a legislative hearing, the Muñoz family is planning to testify against it.

Marlise’s relatives are also readying legislation of their own. Before Texas’ legislative sessions ends on March 13, they’re planning to partner with a different lawmaker to announce an effort to change the current law regarding pregnant women’s end-of-life wishes.

The competing legislation could dredge up the same issues that arose over the high-profile battle for Marlise’s body. Reproductive rights proponents condemned the hospital’s actions as frightening and dehumanizing, decrying Texas for using a dead woman’s body to incubate a fetus, while anti-abortion groups lamented the fact that the federal judge didn’t fight to protect the unborn child.

But the issue doesn’t fall neatly along the traditional battle lines in the abortion rights debate. Marlise’s family members have alwaysmaintained that their quest to honor her end-of-life wishes wasn’t “about pro-life or pro-choice.” They said Marlise never wanted to be hooked up to machines, and they wanted to honor her memory — and say goodbye.

Haimowitz agrees, and says that’s why she was compelled to focus on the case. She was interested in using the documentary format to bring more nuance to the complicated questions surrounding bodily autonomy, pregnant women’s rights, and the far-reaching consequences of laws that are framed in terms of fetuses.

“I think a lot of people, when they hear about this case, they tend to think it’s a really black or white issue. But actually, one of the biggest questions this film asks is — who do you think should have the right to make this choice?” Haimowitz said. “I’ve had a lot of conversations with people about the film who start off by saying, I want you to know I’m pro-life, and I don’t believe in abortion, but I feel really strongly that the government overstepped its bounds in thinking it could make this choice for this family.”

Haimowitz is hoping to finish her project next year, and is optimistic that it might spark more conversation about the issue of gender-based discrimination in advanced directive laws. Right now, more than 30 states have a “pregnancy exclusion” in their policies governing wills, advanced directives, and end-of-life care. These laws ensure that women don’t have the same freedom to plan for their deaths as men do, because their wishes may be invalidated if they become pregnant.

“The security that people are given by being able to write wills, make out advanced health care directives, make plans for their families is very important,” Lynn Paltrow, the executive director of National Advocates for Pregnant Women, told ThinkProgress. “It’s one of many laws that really make it clear that there really is a second-class status for people who have the capacity for pregnancy.”

Paltrow’s organization closely tracks the impact of fetal harm laws on women. In addition to pregnancy exclusion laws, there are other ways that carrying a fetus makes women more vulnerable to gender-specific legal scrutiny. Overly broad “fetal protection” or “unborn victims of violence” laws allow states to prosecute pregnant women for activities that allegedly harmed their pregnancy, like using drugs or attempting suicide. In states with these laws on the books, unexpected health events like miscarriages or stillbirths can put women at risk of being charged with doing something to provoke the pregnancy loss. In 2013, Paltrow and her colleague Jeanne Flavin published a study that confirmed these laws are being used not to protect pregnant women from crimes committed against them, but rather to target those women themselves for prosecution.

Many Americans simply aren’t aware that these policies exist, according to Paltrow, and are really surprised to discover that so many states don’t have to honor a pregnant woman’s end-of-life wishes. Cases like Marlise Muñoz’s are bringing more awareness to the controversial legal precedent of discriminating against people who become pregnant, as well as providing a powerful illustration of the ways in which laws that target women can end up hurting entire families.

Haimowitz echoed that sentiment. She wasn’t aware that so many states had pregnancy exclusion laws on the books until the Muñoz case unfolded in the headlines. “The idea that the state could have that control over someone’s body, even over their dead body, was just shocking to me,” she said.

As the information becomes disseminated more widely, Americans are increasingly motivated to action; in addition to the upcoming legislation in Texas, lawmakers in Wisconsin have already proposed a bill to repeal the pregnancy exclusion in that state’s advanced directive policies. Haimowitz, who interviewed Paltrow for her forthcoming film, hopes her documentary might be an agent for that type of change.

“I think a good documentary film will really humanize a social issue in a way that few other things can,” she said. “Next year is an election year and I think people should be talking about this issue, and I think a documentary would be an excellent vehicle to get them talking about it again.”

]]>The Poorest Women Are Being Priced Out Of Family Planninghttp://thinkprogress.org/health/2015/02/27/3627817/low-income-unintended-birth/
Fri, 27 Feb 2015 14:06:22 +0000Tara Culp-Resslerhttp://thinkprogress.org/default/2015/02/27/3627817//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2015/01/AP060715020552-321x214.jpg"Abortion is a difficult choice, but it is not one that should influenced by financial status," a new report concludes.

A new report from the influential think tank Brookings Institute provides clear evidence that low-income women are being priced out of their ability to control their fertility and plan their family size.

According to the paper, women living in poverty are five times more likely than more affluent women to experience an unplanned birth. The researchers note that “since unintended childbearing is associated with higher rates of poverty, less family stability, and worse outcomes for children, these gaps further entrench inequality.”

In order to figure out what policy solutions might help address this, the Brookings researchers wanted to understand where exactly the discrepancy comes from. So they examined the three factors that contribute to unintended births: The rate of sexual activity, the rate of contraceptive use, and the rate of pregnancy termination. They wondered if any clear differences would emerge across class lines.

They found that sexual activity among unmarried Americans is pretty constant, no matter how much money they have. “There is no ‘sex gap’ by income,” the researchers conclude. Considering the fact that premarital sex has been the norm in this country for the past several decades, that’s not incredibly surprising.

But some gaps did emerge when they looked at who exactly is accessing contraception and abortion. Low-income women are more likely to be having unprotected sex without the use of birth control, which puts them at greater risk for an unplanned pregnancy, but they’re much less likely to get an abortion. In fact, the abortion rates for affluent women are more than three times higher than the rates for the most impoverished sector of the country:

Thanks to the hundreds of state-level abortion restrictions that have been imposed over the past several years, it has become more difficult and more expensive for women to have an abortion. Harsh laws ensure that Americans must navigate logistical hurdles that ultimately drive up the price tag, which presents a particular challenge for impoverished women.

For instance, 11 states have mandatory waiting period laws that require women to make two separate trips to an abortion clinic — which means they must take additional time off work, pay more for transportation, and potentially even stay overnight in a hotel if the clinic is hundreds of miles away from their home. Plus, abortion is routinely excluded from low-income women’s insurance plans, leaving them to shoulder the full cost of an unexpected health event on their own.

In fact, a recent ThinkProgress investigation calculated that an archetypal women living below the poverty line in Wisconsin, where many of these stringent anti-abortion laws are currently in effect, could pay up to $1,380 to end a pregnancy. That type of expense is insurmountable for many individuals who are already struggling to make ends meet. Previous research has confirmed that some low-income women are unable to get an abortion because it takes them too long to save up the money for it.

The Brookings researchers conclude that we need to make some changes to address the deeply entrenched economic inequality that prevents low-income women from controlling their fertility. They acknowledge that the U.S. needs more policies to increase low-income women’s access to long-acting reversible contraceptives, like IUDs, which have already been proven effective at reducing the rate of unintended pregnancy among that population. But they also note that removing the financial barriers to abortion is part of the equation, too.

“Access to affordable abortion also matters, and this is currently limited for many low-income women,” the report concludes. “There are of course strongly-held views on abortion, but it should be hard for anyone to accept such inequalities by income, especially when they are likely to reverberate across two or more generations. Abortion is a difficult choice, but it is not one that should influenced by financial status.”

On the first day of this year’s Conservative Political Action Conference, right-wing attendees gathered to discuss how to get pro-life Republicans elected in blue states. New Jersey Gov. Chris Christie (R) was held up as a prime example — applause erupting to praise the potential presidential contender for vetoing funding for Planned Parenthood five times over the past five years.

“I ran as a pro-life candidate in 2009 unapologetically, spoke at the rally on the steps of the statehouse. I was the first governor to ever speak at a pro-life rally on the steps of the statehouse in the state of New Jersey,” Christie told the approving crowd. “And I vetoed Planned Parenthood funding five times out of the New Jersey budget.”

Christie does present a good case study in what can happen when anti-choice lawmakers head traditionally left-leaning states. Although many Americans may not equate New Jersey with a place like Texas, which has dominated the headlines for its recent policies that have thrown reproductive health clinics into disarray, the family planning landscape in Christie’s state is bleak.

In 2010, Christie eliminated all family planning funding in New Jersey, cutting off $7.5 million that used to support 58 clinics. Thanks to midterm elections that ushered in a wave of GOP lawmakers, a lot of states started cutting their family planning budgets in 2010. But New Jersey was the only one to eliminate state funding altogether. The Guttmacher Institute, a think tank that tracks state-level policies related to reproductive rights, called it a “drastic measure.”

It was a sharp departure for the progressive state. As the New Jersey Spotlight reported at the time, “For a state that began financially backing family-planning clinics in 1967, increased grants nearly every year since then, and endeavored to build a network accessible to all women in every county, it’s a 180-degree turn.”

The state legislature has repeatedlyattempted to restore the funding cuts, but Christie has resisted every year. Senate Majority Leader Loretta Weinberg (D) has accused the governor of trying to drag New Jersey back to the 1950s in order to pander to the social conservatives who might support a 2016 presidential run.

“It is shameful that the governor is playing politics with the health of the women of New Jersey,” Weinberg said in 2013 after Christie rejected her proposal to reverse the cuts. “Women and families in communities across New Jersey have lost access to cancer screenings, prenatal care, STD testing and treatment and birth control.”

At the same time, the federal Title X funds available for family planning clinics have been shrinking, too. After the most recent economic recession, as more Americans slipped into poverty, Title X’s patient load increased, but its budget didn’t.

“Over the past few years, the family planning network in New Jersey has been hit by a triple whammy of federal funding cuts and an elimination of the state funding program on top of a tough climate for nonprofits where fundraising has declined nationwide,” Clare Coleman, the president of NFPRHA, told ThinkProgress via email. “While we work at the federal level to restore funding, we urge similar action in New Jersey and other states to invest in family planning care.”

Although Christie couches his position on family planning funding in the language of the GOP’s war on Planned Parenthood, supporting family planning isn’t antithetical to Republicans’ priorities. Some GOP leaders recognize the financial benefits of Title X. Earlier this year, House Budget Committee Chairman Paul Ryan (R-WI)’s audit of federal anti-poverty programs acknowledged that the program is “moderately effective” at providing low-income women with health services.

A scientist holds up a petrie dish smothered in a varient of the E.coli bacteria.

CREDIT: AP Photo/PA-Adam Butler

Four years ago, three government agencies joined forces to attempt to determine the food sources for common pathogens like salmonella, E.coli, listeria, and campylobacter. Their efforts have culminated in a 12-page document that provides the answers to those questions.

In its new report, the Centers for Disease Control and Prevention (CDC), The Food and Drug Administration, and the U.S. Department of Food and Agriculture’s Food Safety and Inspection Service attributed more than 80 of E.coli cases to beef and leafy vegetables, more than 80 percent of campylobacter illnesses to dairy and chicken, 80 percent of listeria cases to dairy and fruit, and more than 70 percent of salmonella cases to seeded vegetables, chicken, beef, and pork.

The agencies compiled these findings by using foodborne illness source attribution, a process of estimating the most common food sources responsible for foodborne illnesses by using data that involves the use of information collected during outbreak investigations, infections not associated with outbreaks, and food product testing.

“Having these estimates help us understand the scope of the public health problem,” the multiagency team — known as the Interagency Food Safety Analytics Collaboration (IFSAC) — wrote in the report.

“Determining the types of food that cause foodborne illnesses will not only guide efforts to improve food safety, but will also help identify opportunities to influence food safety policy. Regulatory agencies can use source attribution estimates to inform agency priorities, support development of regulations and performance standards and measures, and conduct risk assessments, among other activities,” the report said.

Foodborne illnesses, which strike nearly 48 million people and kill nearly 3,000 people annually, have been a topic of great discussion in recent years. Even with the CDC’s best efforts to decrease the instances of food poisoning, rates of some pathogen-causing illness have stagnated while others have increased. While the IFSAC’s use of food illness source attribution would better allow the IFSAC to pinpoint the products that have the highest risk of carrying pathogens, much of the criticism around food safety has centered on what has been described as an unreliable inspection process.

In 2009, the now-defunct Peanut Corporation of America knowingly shipped its salmonella-tainted products around the country and sent customers tests results from clean batches under the FDA’s radar. The act of deception caused more than 700 illnesses in 46 states, the largest food recall in U.S. history, and the first ever criminal trial of a food manufacturer. In 2011, Listeria-tainted cantaloupe from Colorado sickened nearly 150 people in 28 states, 36 of whom died. In August of that year, Cargill, Inc. recalled 36 million pounds of ground turkey after authorities linked the batch to 79 illnesses across 26 states.

Lawmakers have attempted to strengthen food regulations and hold manufacturers accountable by way of the Safety Reporting Portal and the Food Safety Modernization Act but federal regulations only require the FDA to release information about food safety violations by the end of the year.

Additionally, the food inspection system that’s governed by 30 laws and maintained by more than a dozen government agencies hasn’t been able to effectively inspect domestic products and imports reaching U.S. shores. Agencies often overlap in their duties and duplicate inspection and training activities that slow down the inspection process and cost taxpayers at least $14 million annually.

A solution might be on the horizon. Earlier this month, the Obama Administration released a 2016 budget that would consolidate the 15 federal food regulatory agencies to set food safety standards, streamline the food inspection process, and better enable officials to hold manufacturers accountable. The entity, which would be named the Food Safety Administration, would be housed under the Department of Health and Human Services. It has the potential to better target major foodborne pathogens, especially with food illness source attribution at its disposal.

However, Doug Powell, a former professor of food safety at Kansas State University, remains skeptical that food safety inspection and regulation would better work under one agency. Other people share his sentiments, citing the level of bureaucracy within the Department of Homeland Security and agencies into other countries.

“The research doesn’t support the idea that a single agency would protect food safety any more than the system U.S. currently has in place,” Powell told the New York Times. “Look at the United Kingdom and the horse-meat scandal or Canada, which had a massive beef recall a few years ago. Both of those countries have single food safety agencies, and it didn’t stop contaminated products from reaching the public.”

]]>Conservatives Try And Fail To Offer New Alternative To Obamacarehttp://thinkprogress.org/health/2015/02/26/3627535/cpac-obamacare-panel/
Thu, 26 Feb 2015 17:42:31 +0000Kira Lernerhttp://thinkprogress.org/default/2015/02/26/3627535//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2015/02/AP67113354885-321x214.jpgThe lawmakers and policy expert on a panel called "The Conservative Replacement to Obamacare" could offer no new ideas for alternative legislation.

Days before the Supreme Court will weigh whether to gut the Affordable Care Act, conservatives gathered on Thursday, the first day of the Conservative Political Action Conference, to pitch their ideas for how to replace the law Republicans have unsuccessfully voted to repeal more than 50 times.

Unfortunately, the lawmakers and policy expert on a panel called “The Conservative Replacement to Obamacare” could offer no new ideas for alternative legislation.

Sen. John Barrasso (R-WY) and Rep. Marsha Blackburn (R-TN) agreed that the president’s healthcare law should be struck down — either by the Supreme Court in King v. Burwell, the suit that claims the federal subsidies in the law are unconstitutional, or by winning the White House in 2016.

“More and more people are going to be subsidized in a way we think is illegal,” Barrasso said about the lawsuit during the panel. “We want to use this as an opportunity to get the power out of Washington and back to people at the state level.”

When asked by moderator Amy Frederick, the head of anti-Medicare group 60 Plus Association, for specifics on the “many good ideas out there” to replace the law, the panel didn’t have any new policy ideas to offer. Jim Capretta, a senior fellow with the Ethics and Public Policy Center, pointed to “a couple of very good bills that have been introduced” which he said would provide tax treatment changes, flexibility in the marketplace and movement toward cost reductions.

But the replacement legislation that has been proposed by Republican lawmakers include the same proposals which have been proven to fail. Any credible alternatives would end up having to embrace parts of Obamacare, including allowing children to stay on their parents’ health care plans and mandating insurers to renew policies.

Capretta also praised an alternative that has been proposed by GOP lawmakers Sen. Richard Burr (NC), Sen. Orrin Hatch (UT) and Rep. Fred Upton (MI), but their proposal would roll back some of the major consumer protections, including maternity care for pregnant women. Obamacare mandates maternity coverage in all of the plans sold on its state-level marketplaces to address the gender-biased disparities that were rampant in the individual market before the legislation was signed.

Early in 2014, a similar trio of Republican lawmakers proposed a nearly identical alternative to Obamacare that never got off the ground. But their solution would also have kicked millions of Americans off their health plans, would do little to protect those with pre-existing conditions and would have provided fewer subsidies for those living at the poverty level to buy healthcare.

Republicans are unlikely to endorse any proposal that would guarantee universal coverage, so any alternative would fall short of current law. For instance, while the ACA extends insurance to some 30 million people, a 2009 GOP proposal would have only covered 3 million people.

Over the past several years, the Republican party has not been able to unite around a single Obamacare replacement, and outside observers have become increasingly skeptical that Republicans have any kind of viable alternative at all.

The Supreme Court will hear oral arguments in King v. Burwell next week. If the court were to strike down the law, 8.2 million Americans would lose their healthcare coverage, many of whom have life-threatening conditions.

Amid ongoing controversy over the way that colleges and universities handle rape cases, some schools have positioned themselves as leaders in the push toward reform. It can be a risky move. When universities attempt to become public examples of places that are getting it right, their own students may see things pretty differently.

That’s exactly what’s currently unfolding at UC Berkeley, where more than 500 university administrators and staff members from across the country convened this week for a national conference to address campus violence.

A campus spokesperson told the Associated Press that the event was intended to give educate college counselors, deans, and student affairs coordinators “a frank look” at the current sexual assault crisis and why so many students feel dissatisfied with the way their cases proceed. The conference included sessions related to bystander intervention programs, supporting students who are healing from trauma, and designing internal adjudication systems to ensure a fair process for accused students.

But over the past two days, the conference sessions have been plagued by protests from Berkeley students who say that their school shouldn’t be help up as an example of a place that’s supporting survivors.

Berkeley is one of the dozens of schools currently under federal investigation for allegedly mishandling rape cases in violation of Title IX. Sofie Karasek, one of the sexual assault survivors who joined in that Title IX complaint, told ThinkProgress it’s “extremely insulting” that her school is hosting a conference about how schools can go above and beyond what’s legally required under the law.

“It’s insinuating that Berkeley is already a role model for handling sexual assaults,” Karasek wrote in an email. “We are upset that while survivors have been publicly calling on the University of California to change for over two years, we’re continuing to hear from students and friends that they’re being disbelieved, mistreated, and betrayed when they try to seek support or report sexual assaults.”

Protesters crashed the conference on Tuesday and Wednesday to draw attention to their criticisms about During one panel discussion, students with duct tape over their mouths held signs displaying quotes that survivors say they encountered while attempting to work with the university to file a sexual assault complaint. Students also used those quotes to line the steps of the building where the conference’s keynote speech was held.

One of the quotes, for instance, is along the same lines as the common trope comparing rape to unlocked bikes and burglarized homes. Karasek said that a school psychologist told a survivor of sexual assault: “What happened to you was like when someone takes their iPhone to Bart and decides to use it while riding Bart. You know it’s dangerous, but you do it anyways. It also wasn’t right for someone to take your iPhone.”

The implication is that there are common-sense prevention measures that people should take to avoid becoming the victim of a crime. But critics say that’s a victim-blaming attitude that puts the onus for rape prevention on the wrong person.

Activists also allege that Berkeley didn’t seek survivors’ input during the planning stages of the conference, or seek them out to invite them to speak on the panels. University officials have disputed that claim — in a statement provided to the press, a UC Berkeley spokesperson said that “student government leaders were on the conference planning committee, and other students were involved in workshops and presentations” — but the protesters say the school chose to include students who have not been involved in this issue over the past several years.

“Berkeley officials are quick to applaud student activists for raising the issue of campus sexual violence, but then when it comes to actually inviting us to the conference or having us share our experiences to improve the campus response in general, they don’t even bother inviting us,” Karasek said. “There is a systemic, pervasive dismissal of student survivors who have been raising their voices and speaking out about what’s wrong and how to improve our campuses.”

It’s clear that colleges want to make progress in this area, particularly now that the White House has turned its attention toward campus sexual assault. But figuring out the best way to accomplish that is a messier question, particularity as elite institutions are invested in maintaining their good reputations. Survivors have been skeptical of the paid consultants that colleges have hired to help get them in compliance with Title IX, and have accused administrators of making policy changes that are solely PR moves.

Our gendered expectations about the way that men and women should behave can actually have a tangible impact on Americans’ health outcomes, new research conducted by epidemiologists at the Yale School of Public Health suggests.

Previous research has confirmed that women are more likely than men to delay seeking medical care for their health issues, particularly when money is tight, largely because they choose to care for their children before caring for themselves. But on top of that, young women tend to ignore the symptoms of heart disease — and they’re more likely to die because they don’t seek immediate treatment during a heart attack.

Judith Lichtman, an associate professor of epidemiology at Yale, wanted to figure out where that discrepancy comes from. What are the specific barriers standing in the way of women getting treatment for their heart issues? In order to find out, she and her colleagues conducted a small in-depth study that focused on 30 young women between the ages of 35 and 55 who landed in the hospital after having a heart attack.

Many of those women said that they didn’t know what a heart attack felt like, or that their doctors didn’t recognize the signs. Particularly when they occur in women, heart attacks can be signaled by seemingly unrelated symptoms like nausea, shortness of breath, or jaw pain. And health providers still have some gaps in their knowledge about how exactly heart disease affects young women.

But, in an interview with NPR, Lichtman explained that even the women who did recognize the symptoms and suspected they were suffering a heart attack were still hesitant to push for treatment. They didn’t want to seem like they were overreacting or being hypochondriacs. “We need to do a better job of empowering women to share their concerns and symptoms,” Lichtman said.

The finding that some women are too timid to speak up about their medical concerns was particularly interesting to Dr. Jennifer Tremmel, a cardiologist at Stanford University, who pointed out that this is actually a widespread gendered issue for doctors and patients.

“It’s interesting because the whole idea of female hysteria dates back to ancient times,” Tremmel told NPR. “This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they’re afraid there’s something wrong.”

The modern-day stereotype that all women are “crazy” and “emotional” can be traced back to the historical notion of female hysteria, which was once considered to be a mental disorder. Women have been being described as hysterical since at least 1600 B.C., when ancient Egyptians attributed hysterics to the misplacement of the uterus. In the 1800s, women who attempted to rebel against the domestic expectations for their gender in the Victorian Age were labeled hysterical and placed in mental asylums.

Although modern medical practice has moved on — “hysteria” was removed from the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the so-called “bible” of the mental health field — the subtle societal expectations about the ways women should or should not express their emotions have not. Women are still shamed for having emotional reactions and labeled as “crazy” as a way of invalidating their feelings, a dynamic that modern feminists label as “gas lighting.”

According to Robin Stern, who authored the book The Gaslight Effect, women whose feelings are frequently invalidated in this way may have trouble making their own decisions, start constantly second-guessing themselves, or conclude that their concerns aren’t worth articulating because they’re simply being too sensitive.

Delaying medical care isn’t the only potential medical consequence stemming from the reinforcement of gender stereotypes. Previous research has found that young men and women may regulate their behavior in harmful ways when they’re trying to adhere to strict gender roles. Young men may behave physically aggressively or abuse alcohol, while young women may unhealthily restrict their diets.

Two new studies have added to the mounting evidence that HIV transmission can be virtually prevented if HIV-negative individuals take PrEP (pre-exposure prophylaxis) — also known as “Truvada” — a daily pill with similar medication as is used to actually treat HIV.

Both were unveiled this week at the Conference on Retroviruses and Opportunistic Infections in Seattle. The first, known as the UK PROUD study, originally began as a comparison between a group of gay men taking PrEP and a group that was going to wait a year before begin taking PrEP. So many in the latter group were becoming HIV positive that everybody in the group was immediately offered PrEP.

Ultimately, PrEP reduced the risk of HIV by 86 percent. Only 3 individuals in the group offered PrEP immediately became HIV positive. One of them was found to be positive so early into the study that it is likely he may have seroconverted as he entered the study and thus did not have a chance to benefit from the PrEP. The other two were out of contact with the clinic for extended periods of time and thus unable to renew their prescriptions, suggesting they were not adherent to PrEP usage at the time they were infected.

As previous studies have confirmed, usage of PrEP did not cause users to engage in riskier behaviors. Both groups experienced similar levels of non-HIV sexually transmitted infections, suggesting their behavior did not change if they were using PrEP. As the authors explain, “The preoccupation of some policy professionals with behaviour changes — termed “risk compensation” — was one of the motivations for this pilot study rather than general early access. As with other PrEP studies, PROUD has provided evidence to allay this concern.”

In the other PrEP study, known as Ipergay, found a near-identical reduction in risk for HIV infection of 86 percent. That study included gay men, and other men and transgender women who have sex with men. As in the PROUD study, there were just two infections among those who were using PrEP, and both had discontinued use of the medication several weeks before infection occurred. Among those who were receiving a placebo, infections were much more common, unsurprisingly, for couples not using condoms.

Just this week, the Center for Disease Control and Prevention (CDC) released a new analysis that found that 9 out of 10 new HIV infections come from people who are not receiving care for their HIV. As many of 30 percent of those new infections were transmitted from people who did not know they were infected, a result that jibes with Kaiser Family Foundation’s finding that only 30 percent of gay and bi men have been tested for HIV in the past year. The CDC, along with the World Health Organization, recommends the use of PrEP for anybody who feels they might be at risk of infection.

]]>Pediatricians Fight Back Against Anti-Vaxxers, Ban Their Kidshttp://thinkprogress.org/health/2015/02/25/3627108/doctor-vaccinate-survey/
Wed, 25 Feb 2015 18:40:37 +0000Sacha Feinmanhttp://thinkprogress.org/default/2015/02/25/3627108//http://d35brb9zkkbdsd.cloudfront.net/wp-content/uploads/2014/05/shutterstock_39232063-321x214.jpgA new survey finds that many doctors are ready to take a strong stance in favor of vaccination.

According to a national analysis conducted by an employee at the Vermont-based Physicians Computer Company (PCC), the majority of U.S. pediatricians will turn away patients who refuse to vaccinate their children. The findings come on the heels of California’s ongoing measles outbreak, which has renewed a broader dialogue over vaccine policy, making doctors’ approach to the issue a national concern.

Chip Hart, the company’s Director of Strategic marketing and principal author of the study, discovered that 54 percent of the nearly 500 practices surveyed have some vaccine requirement, and will refuse treatment to parents who don’t comply.

Hart told ThinkProgress that he was surprised the numbers were that high. “I didn’t think it would be a majority,” he said. “My gut feeling was that it would be in the 30-40 percent range.”

PCC brands itself as a consulting firm for pediatricians. Since the early 1980s, the business has offered goods and services to help doctors manage their schedules, pay their bills, and track vital issues like immunization rates. This pre-existing network allowed Hart to mail his survey out to roughly 5,000 pediatricians across the country, of which 497 responded.

“Although it’s possible that we have some selection bias,” he acknowledged, “I think we’ve got a pretty good spread of pediatric practices in the results.”

Since at least one person infected with measles visited Disneyland during the year-end holidays, California has been grappling with an outbreak that has resulted in 123 cases across 12 counties, at least 39 of which have been directly linked to the theme park. The outbreak has put the spotlight back on people who choose to forgo federally recommended vaccines. Although the CDC reported that the United States officially eliminated the measles in 2000, pockets of people resisting vaccination have given the disease a chance to return.

For over a decade now, a small but vocal population of skeptics has painted the pro-vaccine community as enthralled with “Big Pharma.” They claim that mainstream medicine pushes unnecessary and even toxic shots on the general public as a means of generating corporate profit. The measles vaccine has been particularly contentious. While critics maintain that this shot can cause autism, the Centers for Disease Control and the overwhelming majority of medical scientists refute that claim, since it’s been scientifically disproved time and again.

The recent spread of a preventable infectious disease has led California legislators to propose a policy solution: Tightening the state’s personal belief exemptions for childhood vaccines. As it currently stands, parents in this state are able to enroll their children in school without immunizations if they can first prove they’ve visited a doctor. Exceptions are also made based on religious beliefs.

It’s an unsettled ethical dilemma. According to the American Academy of Pediatrics, “In general, pediatricians should avoid discharging a patient from their practices solely because a parent refuses immunizations for the child.” But some pediatricians have recently spoken out in favor of the opposite position, saying that they need to protect their patients.

As Dr. Eric Bell, a pediatrician in Southern California, told NPR earlier this month, “I have several patients a day who have threatened to leave our practice if we are still going to see patients that are unvaccinated. They do not want to see patients with measles or whooping cough in our waiting room for fear their baby might get sick from it.”

According to Hart’s findings, of the pediatricians who require that patients vaccinate, 98 percent specifically necessitate the MMR inoculation that protects against measles.

Hart also found that, among the practices that made the switch to a vaccine requirement, 58 percent lost a few patients. But 61 percent of practices received a positive reaction from the patients who remained, while only 2 percent noted a negative reaction.

Perhaps the most provocative finding involves parents’ response to doctors taking a stand. Of the practices that switched to a vaccine requirement, 68 percent reported that some new families opted to comply, and 17 percent answered that many new families permitted their children be vaccinated.

“This last bit gets at whether or not a doctor should even begin by assuming that there is a space for questions on vaccinations,” Hart said. “If you advertise that you don’t require vaccines, that solidifies the distrust of them. If you, as a physician say, ‘I’m not going to make you do this’ then the patient thinks it’s just not that important.”

In an interview with CBS last month, Dr. Margaret Van Blerk, a pediatrician in Orange County, California, expressed the frustration that often results when patients are given the option to opt out of vaccines. “It’s just frustrating that they don’t listen,” she lamented, “because they come to us to take care of their children, and yet they don’t trust us.”

While the paternalistic view that doctors know best and should assert their power accordingly is not without controversy, there is some evidence to support the claim. A widely cited study published in the Journal of the American Academy of Pediatrics concluded that, “Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes.”

Migrant workers separate freshly caught fish by size at a fish market in Samut Sakhon Province, west of Bangkok, Friday, June 20, 2014.

CREDIT: AP Photo/Sakchai Lalit

Perennial physical, mental, and emotional abuse can take a toll on a person’s psyche long after they escape harrowing conditions. A recent study that focused on survivors of human trafficking highlighted this unfortunate reality, reaffirming the need for long-term mental health care for populations suffering from invisible wounds.

Researchers in London interviewed more than 1,000 men, women, and children in Southeast Asia who were rescued by local organizations two weeks prior to the study. The interviewees — who had been forced into sex work, commercial fishing, agricultural business, and other labor intensive industries — recalled long work days, perpetual bondage, severing of body parts, and being shot at and stabbed.

For many of them, the pain didn’t stop after they escaped physical bondage. More than 60 people in the study showed signs of depression. Nearly 40 percent reportedly had anxiety and post-traumatic stress disorder. Researchers said that these findings — published in a recent issue of The Lancet Global Health — stressed the need for mental health services that go well beyond the duration of victims’ court cases and help them safely reintegrate into their communities, regardless of age, sex, or circumstance.

“Most research to date [on human trafficking] has been conducted on women and sex exploitation,” Ligia Kiss, the study’s lead author and an epidemiologist at the London School of Hygiene & Tropical Medicine, told NPR. “There’s very little research on men and boys, and specific studies on fishermen are still scarce.”

A lack of research about the scope of human trafficking has posed serious consequences for the estimated 29 million people globally who are enslaved, according to a study conducted by the Walk Free Foundation, a global activist organization dedicated to ending modern-day slavery. Ten countries — including India, Pakistan, and China — hold nearly 70 percent of those in physical captivity.

Human trafficking, the third largest criminal enterprise in the world, has taken numerous forms — including prostitution, agriculture, domestic work, and labor in factories and sweatshops producing goods for the global supply chain. Unbeknownst to many, women aren’t the only victims. Many times men, and in some cases families, are thrown into bondage to pay generational debts or fund trips to another place. Members of this population may have already been victims of violence, making them more vulnerable to these types of situations.

“There is no single profile of trafficking victims,” Kiss said. “We found in our sample men, women and children of all different ages, backgrounds and origins, and trafficked into different sectors of work. It is a widespread phenomenon.”

In recent years, mental health professionals have tried to study more closely the effects of the underground slave trade on its victims — particularly those sold into the sex trade — and develop effective treatments. In 2010, a group of Harvard researchers designated unpredictability in abuse as an indicator of negative psychological reactions likely to go on for a long time.

While some trafficked girls and women may not suffer “extraordinary” levels of physical abuse, verbal threats of violence and coercion into sexual acts put them in a fragile state of mind, especially since they have little to no control over when they sleep, what they eat, the number of clients they take, and their use of a condom. This is particularly the case in situations where victims have been moved to another country. For other members of the modern-slave community, forms of control may include threats of police intervention — especially in cases when they’re smuggled into a country illegally — the withholding of money, the threat of the use of weapons, and isolation from support networks.

Those who experience physiological abuse at the hand of their captors often become exhausted and debilitated, have trouble concentrating, abuse substances, and develop feelings of despair along with hallucinations and other forms of psychotic reactions. These effects come from the feelings of helplessness caused by the torture and the economic and social captivity that researchers say makes victims of human trafficking subconsciously dependable on their captors long after their release. Those who don’t have access to effective treatment have difficulty controlling emotions, a detriment to their overall well-being.

“Captivity creates a unique relationship of coercive control between the perpetrator and the victim,” Elizabeth Hopper and Jose Hidalgo wrote in their 2006 article titled Invisible Chains: Psychological Coercion of Human Trafficking Victims. “As victims become more isolated, they grow increasingly dependent on the perpetrator, not only for survival and basic bodily needs, but for information and even emotional sustenance. The purpose of such psychological coercion is to increase control over other persons and… support their ability to exploit others for personal and financial gain.”

Even with these services at their disposal, however, realizing full psychological rehabilitation comes with difficulties for survivors of human trafficking. First, law enforcement officials have to establish a trusting relationship with victims, a huge undertaking in itself that most rehabilitation programs — many of which provide services for a short duration — don’t take into account. Helping victims require taking the time to allay their fears of retaliation from their captors and challenge their perception that police officers aren’t to be trusted. Victims may also have feelings of shame that discourage them from opening up to mental health professionals.

Accessing mental health services may also be a problem in itself if victims don’t have proper identification and insurance. Those who don’t fall through the cracks and gain access to mental health care may find that it doesn’t fit their needs or takes into account what may be a lengthy healing process. Funding restrictions often limit the number of sessions a victim can receive. Treatment options, such as isolation in facilities, can also conjure memories of abuse in human trafficking victims. Under these conditions, victims of human trafficking stand a great chance of never meeting the “expectations” of their mental health practitioners.

]]>Last summer, when arguing in court in favor of Senate Bill 206, a harsh law that would force at least one of Wisconsin’s abortion clinics to close its doors, a state official compared ending a pregnancy to buying a fancy car.

“If I decided I’m going to buy a Mercedes-Benz but I cannot get financing for that car and I don’t have the funds to buy it, am I prevented from buying a Mercedes-Benz?” Assistant Attorney General Clayton Kawski asked an expert witness during the hearing.

Reproductive rights proponents retorted that basic women’s health care is hardly a luxury good. But for many of the pregnant women who struggle to navigate a maze of state laws that make it increasingly burdensome and expensive to get an abortion, it might as well be.

A ThinkProgress examination of the potential fees that could be accrued by two archetypal Wisconsin women found that the process of obtaining an abortion could total up to $1,380 for a low-income single mother saddled with charges related to gas, a hotel stay, childcare, and taking time off work. For a middle-income woman living comfortably in a city with no children and public transit options to the clinic, meanwhile, those fees dropped to $593.

People who are low-income who face other barriers in trying to access health care will always be the ones who are affected by it.

Like all medical procedures, the cost of an abortion varies widely depending on the clinic and the state. Prices also change depending on the gestation of the pregnancy and the type of anesthesia a patient may require. While there is no standard fee on a state or national level, out-of-pocket costs for an abortion can range anywhere from $375 in the first trimester to $6,531 at 22 weeks, according to national data collected by ThinkProgress.

And that doesn’t account for the fees that accumulate as a result of the legislative barriers to the procedure, which end up disproportionately burdening women of limited resources and economic means. For instance, abortion is routinely excluded from Americans’ insurance plans, leaving many patients to shoulder the entire cost of an unexpected health event on their own.

“Any time we see these restrictions, it means that people who are low-income who face other barriers in trying to access health care will always be the ones who are affected by it,” said Lindsay Rodriguez, the communications manager at the National Network of Abortion Funds, which is comprised of dozens of state-level organizations that help women pay for their abortions.

The mounting fees can quickly become prohibitive. According to researchers at the University of California, San Francisco, more than 4,000 women were denied abortions in 2008 because they were past the gestational limit — largely because it took them too long to try to save up the money for it. Nearly six in ten participants said they couldn’t get an abortion earlier because of travel and procedure costs.

These restrictions, the researchers concluded, “present an undue burden because many women do not realize they are pregnant until later in pregnancy and cannot travel to other states for abortion care. Additionally, women who raise children born from unintended pregnancies have higher rates of economic and educational disadvantages.”

The real-world consequences stemming from this web of complex restrictions are evident in Wisconsin, where a decision on SB 206 could be handed down at any time over the next few months. If SB 206 is allowed to take effect, doctors will be required to have medically unnecessary admitting privileges from local hospitals, which reproductive health advocates say would force at least one of the state’s clinics to shut down. But even aside from the looming threat of more clinic closures, legislative hurdles ensure that it’s no easy feat to get an abortion there.

“We’re in a horrible situation here in Wisconsin, and I don’t think people are aware until they need an abortion,” said Rep. Chris Taylor (D), the former public policy director for Planned Parenthood of Wisconsin and a fierce advocate for reproductive rights in the state legislature. “It’s just totally humiliating and degrading, the whole process for women.”

To begin with, women’s geographical access to the procedure is limited. There are currently only four clinics operating in the state: Two in Milwaukee, one in Madison, and one in Appleton, a quaint city tucked in the northeast region of Wisconsin. If patients live outside of those three areas, transportation is one of the biggest issues that they face, according to Nicole Safar, the current policy director at Wisconsin’s Planned Parenthood affiliate. “Wisconsin is an incredibly rural state and it’s not easy to get from one metro area to another if you don’t have a car,” Safar said.

We’re in a horrible situation here in Wisconsin, and I don’t think people are aware until they need an abortion.

And even if women do have access to transportation, there’s no guarantee they will be anywhere near a clinic — more than 95 percent of the state’s counties are without one. As one young woman from Madison who preferred to remain anonymous told ThinkProgress in an email: “My family has a cottage in rural Wisconsin and I have absolutely no idea where one would find an abortion in that part of the state.”

Women are also legally mandated to have an in-person counseling session with a doctor who must show them illustrations of a fetus at various stages of pregnancy. The state requires them to have a mandatory ultrasound; their doctor must also show and describe those images to them. After that initial consultation, they must wait at least 24 hours before they’re allowed to return to the clinic.

This requirement — also known as a waiting period — has “dramatically” increased the burden on women in the state, according to Nora Cusack, the treasurer of the Women’s Medical Fund, a nonprofit organization that assists Wisconsin residents who need help paying for an abortion and helps fund around 700 procedures annually. While 26 states across the country have some type of waiting period in place, Wisconsin is one of just 11 that stipulates the initial counseling session must take place in person, which requires patients to make two separate trips to the clinic. For women who are geographically isolated from abortion providers, this requirement means they must make two round trips or plan an overnight stay at a nearby hotel.

CREDIT: ThinkProgress/Dylan Petrohilos

Then, patients in Wisconsin can finally have their abortion. Until recently, they could only have a surgical procedure, because state lawmakers passed such onerous restrictions on the abortion pill that clinics were forced to temporarily stop offering medication abortion altogether. Both options are available again — but, if women are insured through the Medicaid program or through a plan on Obamacare’s marketplace, their provider won’t cover either procedure.

It’s not hard to see how these logistical hurdles could put a significant financial strain on people who are already struggling. According to research conducted by the Guttmacher Institute, about 42 percent of U.S. abortion patients have incomes that fall below the federal poverty line. Most are unmarried and already juggling parental responsibilities for at least one child. Although the abortion rate has been dropping nationally, that trend isn’t evident among the poorest women, who continue to struggle with a disproportionate number of unintended pregnancies. For those women, the dollar signs add up quickly.

“Most of the women, if they have a job it doesn’t include sick pay, and most of them have kids, and so what do you do with your kids?” Cusack pointed out. “If they have a job they’re in a low-income job, they don’t have benefits, they don’t have health care.”

If they have a job they’re in a low-income job, they don’t have benefits, they don’t have health care.

Jane Collins, a professor of community and environmental sociology and gender and women’s studies at the University of Wisconsin, has conducted extensive research into the policies that affect Wisconsin residents living at the poverty line. At the trial regarding SB 206 this summer, she testified against the state’s admitting privileges law, arguing that decreasing the number of clinics in the state would place an untenable burden on poor women.

During her testimony, Collins pointed out that low-income women wouldn’t be able to afford bus fare or gas money to travel farther from their homes, using basic demographic data on income and household structure to model the negative monetary impact the law would have.

It’s a useful thought experiment that can extend to the women who might currently seek abortion services, even before a ruling on SB 206 is handed down. Imagine a single mother in her late 20s who lives in a small town in northern Wisconsin and works minimum wage jobs in the service sector to support her family. Call her Laura.

Making just about $18,000 per year at two different part-time jobs, Laura can’t afford another child; when she realizes she’s pregnant, she knows she wants to get an abortion. In order to do so, she’ll have to drive about 200 miles from her home in Park Falls to get to the abortion clinic located in Appleton, which isn’t open on the weekends. If she can get two appointments on consecutive days during the week — one for the mandatory counseling session, and a second for the procedure itself — she’ll save time and gas, but she’ll need to shell out money for a nearby hotel.

CREDIT: ThinkProgress/Andrew Breiner

Laura will lose out on $145 in missed wages if she has to skip two days of her regular shifts at work to make the trip to Appleton. She’ll also have to pay someone around $200 to babysit her child while she’s gone. (That’s according to Collins’ research, relying on the $10 per hour rate that the state will reimburse overnight child care under the human services department.) The round trip drive to Appleton will cost her about $40 in gas money, assuming her car gets 22 miles to the gallon. Once she’s there, the counseling session will cost $125 and a 13-week surgical procedure will cost $600 out of pocket, according to employees at the Appleton Central Health Center, and Laura’s Medicaid coverage won’t pay for any of it. Laura will need to spend $70 to stay one night in a hotel close to the clinic.

For many women, these collateral fees are untenable — “even an unexpected cost of $44 can pose a burden,” researchers from the Guttmacher Institute wrote in a 2012 report on the costs of abortion services. “For women pulling together money to pay for the procedure as well as transportation and missed work, these relatively small amounts can prove impossible to procure and could prevent women from obtaining a wanted abortion.”

All told, the costs associated with Laura’s abortion total $1,180. That’s assuming she’s a single mom of one. If she has two kids, and needs overnight childcare services for both of them (at the same rates noted above), the price tag could rise to $1,380. If Laura works about 50 hours a week, about 25 hours at each of her part-time jobs, her total abortion costs are equivalent to nearly an entire month of wages.

Among the Americans with annual salaries and savings accounts and credit cards, that may sound doable. An unexpected cost of just over $1,000 could be difficult to swallow, but not completely outside the realm of possibility. That’s not always the case for people living in poverty. Women who are already having trouble coming up with the $500 to $600 dollars they need for their abortion can hardly afford the extra costs that rapidly accrue as a consequence of harsh state laws.

“I think people have a hard time grasping that that $600 can be an absolute barrier. It can be the difference between having your civil rights and not having them,” Collins said. “If you keep adding up the expenses of the extra miles, the need to pay for childcare, you’re going to reach a wall — a point when you’re not going to be able to pay.”

These costs take a special toll on women in communities where English isn’t a typical first language, or where they may lack the necessary identification to travel through border patrol checkpoints in states like Texas, explained Rodriguez. “So even sometimes with all of our resources and everything that we can pull together, the state laws being as they are, there will always be more need than we can provide monetarily.”

$600 can be an absolute barrier. It can be the difference between having your civil rights and not having them.

There are other, less tangible impacts as well. The numbers calculated above don’t necessarily capture the psychological and emotional costs of Laura’s experience. Perhaps she had to beg a friend to lend her their car for the two-day trip, which was a logistical nightmare because most of her friends needed their cars to get to work. Maybe she had to take a loan from family members because she still needed to pay her rent, and was unable to ask for assistance without disclosing her unintended pregnancy, which was uncomfortable. Spending a night away from her child may have been difficult, and traveling from a small rural town to an unfamiliar city — navigating a new area and finding parking — may have been stressful. Asking her boss for time off work could have strained their relationship, forced her to share information she would have preferred to keep private, or even put her job in jeopardy.

These logistical and psychological stressors may not come with a clearly defined price tag, but they can certainly complicate the process for low-income women like Laura seeking an abortion, Collins noted.

“If you wanted to borrow your friend’s car for a couple hours you could probably do that without much of an explanation. But if you’re going to be gone for three days, you need to tell people where you are — the people who have cared for your children, who loaned you the money, who loaned you the car, your partner,” she said. “Those things create stress and potentially breach confidentiality.”

This situation can play out very differently for people with higher incomes and easier access to urban clinics.

Consider a different type of Wisconsin woman in her late 20s, someone we’ll call Mary. She lives in a popular and accessible neighborhood in Madison and makes about $40,000 per year working for a nonprofit organization. If Mary finds out she’s unexpectedly pregnant and wants to have an abortion, she doesn’t have to travel terribly far. There’s one clinic in the city that performs abortions — Planned Parenthood in Madison East — which is a 30-minute bus ride from her apartment and will cost just $4 round trip. She’ll pay the same $125 for the state-mandated counseling session and $460 to take the abortion pill, a non-surgical procedure that is available to her because she was able to make an appointment earlier in her pregnancy. Mary can take two sick days from her salaried job without losing out on pay, she doesn’t have children to worry about, and her employer-sponsored insurance may even cover a portion of the procedure’s fees.

In total, the sum of Mary’s costs are significantly lower than Laura’s — just $593 — and that’s without taking her potential insurance benefits into account. It’s also a much smaller portion of her annual earnings.

The state laws being as they are, there will always be more need than we can provide monetarily.

Of course, not every woman who seeks an abortion will accrue Mary and Laura’s fees, or be forced to navigate the hurdles specific to their circumstances in Wisconsin. Some may live within walking distance of a clinic; others may end up traveling to closer cities out-of state. Some may have generous employer-sponsored insurance plans and mainstream bank accounts; others, who are “unbanked” and unable to access short-term loans through typical banking channels, may end up saddled with debt after borrowing money from pay day lenders.

Regardless of the individual circumstances, however, there are women all over the country who are struggling to afford the cost of their reproductive health care. The Guttmacher Institute has found that about half of the women who seek abortions are forced to ask for outside financial help because they can’t pay for the procedure on their own. “We definitely have seen people who need more assistance than they did before,” Rodriguez said in reference to the hotline workers affiliated with the National Network of Abortion Funds.

When does an abortion become a luxury car? And how expensive does the procedure have to get before the courts are required to step in and preserve low-income women’s rights under Roe v. Wade?

Amid an increasing number of court battles over the same type of admitting privileges law that’s up for review in Wisconsin, these are the questions looming in the forefront of reproductive rights’ advocates minds. As this specific abortion restriction makes its way to the Supreme Court, the dilemma will likely be resolved by the most powerful justices in the country. And proponents of reproductive rights are not necessarily optimistic about how the issue will fare in front of the conservative Roberts Court.

The last Supreme Court case that significantly reshaped abortion policy, Planned Parenthood v. Casey, held that states cannot impose an “undue burden” on women seeking abortions — a vague statute that essentially left the door open for conservative lawmakers to enact new restrictions to test the boundaries of the law. In many ways, Casey hollowed out Roe; it is the vehicle that facilitated the counseling sessions, forced waiting periods, mandatory ultrasounds, and clinic restrictions currently in place across the country. It is why states have been allowed to pass laws specifically intended to shut down women’s health centers .

CREDIT: ThinkProgress/Dylan Petrohilos

And years later, the precise definition of what constitutes an “undue burden” has still not been settled. Lawyers representing abortion providers have repeatedly argued that imposing medically unnecessary barriers to the procedure and regulating clinics out of existence should fall under that category, since those policies ultimately prevent some impoverished women from exercising their reproductive rights. But that argument has not swayed some of the more conservative judges on the appellate courts.

The split is becoming particularly pronounced in the U.S. Court of Appeals for Fifth Circuit, which comprises Louisiana, Mississippi, and Texas — states that have all passed similar admitting privileges laws.

In Texas, where the policy has shuttered dozens of abortion clinics and left poor women along the border with few health resources whatsoever, a federal judge ruled last March that the clinic closures do not show an undue burden. But in Mississippi, where the same policy puts the state’s sole clinic in jeopardy, the courts have been more sympathetic. Lawyers representing the state argued that the law doesn’t represent an undue burden because women can travel to Tennessee, Louisiana, or Alabama to end a pregnancy. But the Fifth Circuit disagreed, ruling that “Mississippi may not shift its obligation to respect the established constitutional rights of its citizens to another state.”

This month, Mississippi appealed that decision to the Supreme Court, saying that the inconsistent rulings from the Fifth Circuit on identical abortion policies need to be resolved. Are admitting privileges an undue burden or not? How few abortion clinics can a state have before women’s reproductive rights are officially violated? They’re big questions, and in order to figure out the answer, it’s impossible to separate — as Wisconsin’s assistant attorney general attempted to do — the legal issues from the economic issues.

At least one sitting member of the U.S. Supreme Court has weighed in on this issue recently. In an interview with MSNBC published this month, Justice Ruth Bader Ginsburg said that abortion has become “inaccessible to poor women” — a reality, she conceded, that is a “crying shame.”

Note On Methodology: To collect the data used in the interactive map, ThinkProgress contacted abortion clinics, abortion funds, and reproductive health organizations in each of the 50 states, and gathered data from research organizations including the Kaiser Family Foundation. When we were unable to independently verify the number of clinics in a state, we relied on data collected by the Guttmacher Institute in 2011. Prices were verified by calling at least one clinic per state, but price ranges are not necessarily reflective of every single clinic there.

Nevada Assemblywoman Michele Fiore (R) wants to reform the rules of end-of-life medical care so that more cancer patients can simply flush out their disease using baking soda.

Fiore, who is also CEO of a healthcare company, told listeners to her weekly radio show on Saturday, that she will soon introduce a “terminally ill bill,” to allow more non-FDA-approved treatments for those diagnosed as having terminal illnesses.

As first reported by Jon Ralston, Fiore told listeners: “If you have cancer, which I believe is a fungus, and we can put a pic line into your body and we’re flushing, let’s say, salt water, sodium cardonate [sic], through that line, and flushing out the fungus… These are some procedures that are not FDA-approved in America that are very inexpensive, cost-effective.” The American Cancer Society warns that while cancer patients whose immune systems are weakened by high doses of chemotherapy can sometimes contract fungal infections, “there is no evidence that antifungal treatment causes the patients’ tumors to shrink.” Cancer Research UK dismisses the claim that sodium bicarbonate (baking soda) can cure cancer as a debunked “persistent cancer myth.”

Fiore added that Nevada is already “the capital of entertainment” and this bill could help “make it the medical capital of the world as well.”

Weeks after being removed from her position as Republican Majority Leader over allegations of more than $1 million in tax liens, Fiore made news last Wednesday for her assertion that “young, hot little girls on campus” need to be armed with guns to prevent themselves from being raped, saying that every citizen should “have the right to defend him or herself from sexual assault.”

In 2012, she proposed arming school officials and college students as a way of combating school shootings.

Although Fiore’s views on cancer are particularly fringe, the bill she is backing is gaining traction in a number of states. At least five states have now passed similar legislation that allows patients to use drugs not cleared by the FDA, dubbed so-called “right to try” bills. The campaign to pass these bills has been led by the libertarian Goldwater Institute.

The Vatican took on “Big Pharma” last week, asking the international community to reform laws that allow drug companies to blindly pursue profits while keeping life-saving drugs out of the hands of poor people.

According to Vatican Radio, last Wednesday Archbishop Silvano M. Tomasi, the Permanent Observer of the Holy See to the United Nations, spoke at a UN Forum dedicated to making medicines more affordable and accessible for people in poorer nations. In his address, Tomasi argued that there are many obstacles that keep poor people from purchasing drugs, but called out one issue as particularly devastating: the abuse of intellectual property laws by pharmaceutical companies.

“A major stumbling block in providing such access is found in restrictive applications and interpretations of intellectual property rights by many in the pharmaceutical industry,” Tomasi said, adding “[The current system] can lead to total disregard for those who cannot afford the price of certain medical products and allow an imbalanced free trade system, and thus constitute a virtual monopoly.”

The Archbishop also noted that most intellectual property systems only incentivize developing medications that accrue the biggest profits, which usually means companies spend the vast majority of their resources making drugs for people in wealthier nations. As such, businesses often fail to develop treatments for maladies common in poorer countries, such as tropical diseases, tuberculosis, malaria, hepatitis, and Ebola.

“It is most regrettable, therefore, that, due to an excessive focus on profit, we witness a preference within much of the pharmaceutical industry to orient research toward health issues that have greater market potential in wealthier industrialized countries,” Tomasi said.

Tomasi didn’t outline specific changes that could be made to intellectual property laws — that would require, among other things, legal shifts in many countries. But he did advocate for “a creative and innovative approach” that “prioritiz[ed] the life and dignity of the world’s most vulnerable people, many of whom bear an inequitable burden of both communicable and non-communicable diseases.”

Intellectual property laws are ostensibly designed to help companies make a profit off of the products they make; basically, if a business puts in the work to create or invent something, the logic goes that they should be able to reap the profits for a time before other people are able to create and sell a similar product. Yet, as the Catholic Church noted last week, the intellectual property system has been repeatedly abused in ways that bolster corporate profits but hurt the world’s poor, 2.6 million of whom die every year from diseases that receive only a fraction of pharmaceutical research money, according to a 2012 report from Doctors Without Borders. The same report noted that only 3.8 percent of approved drugs from 2001 and 2011 were developed to treat “neglected diseases,” or maladies where “treatment options are inadequate or don’t exist” or where “drug-market potential is insufficient to readily attract a private sector response.”

This ruthless pursuit of profits can even lead to epidemics. In January, health care advocates criticized drug companies Pfizer and GlaxoSmithKline for making vaccines too expensive for children in poor countries, and last November the World Health Organization (WHO) cited the pharmaceutical industry’s obsession with the bottom line as the primary reason for a delay in creating an Ebola vaccine: most Western pharmaceutical companies were slow to pursue a vaccine for the disease, WHO officials said, because the virus wasn’t prevalent outside of Central Africa.

The Vatican’s statement helps add a moral heft to intellectual property disputes that have raged for some time — including domestic debates here in the U.S. When lawmakers were crafting the Affordable Care Act (ACA) back in 2010, for instance, there was disagreement over how long drug companies should be able to hold exclusive rights over “biologics,” a powerful — but expensive — new medical treatment that can be used to treat diseases such as rheumatoid arthritis, breast cancer, and possibly even Parkinson’s disease. Prior to the ACA, there wasn’t even a mechanism for creating “generic” biologics in the United States, even though many existed in Europe and Canada, meaning that these life-saving treatments could remain expensive indefinitely. Lawmakers successfully included a provision in the ACA that allowed the FDA to approve generic biologics called “biosimilars,” but while President Barack Obama and others wanted to restrict the market “exclusivity window” — or how long drug companies retain control over medical patents for biologics — to 7 years, pharmaceutical lobbyists prevailed and pushed the period to 12 years in the final law.

The controversy continued, however, and in 2011 the Obama administration proposed reducing the exclusivity window to 7 years, which would result in $3.5 billion in savings over 10 years to federal health programs and get cheaper drugs into the hands of more people more quickly. But pharmaceutical companies have fought hard to retain control over their patents for as long as possible: in 2013, groups such as the AARP noticed that pharmaceutical companies were vying to write the 12-year market exclusivity period into the Trans-Pacific Partnership, a 12-nation trade deal. Doing so would effectively cement the window into national law, and significantly hamper efforts to reduce it to 7 years or lower.

These pharmaceutical companies are rooted in the West, but sell their products to governments worldwide, so domestic disputes over intellectual property rights have international ramifications. Thus, while Catholic Church officials and other health care advocates agree that companies should be able to reap the benefits of their labor, they argue that Big Pharma profits shouldn’t come at the expense of those who need their medicine the most — poor people.

Taking on the drug industry and overhauling a global intellectual property system is a tall order, and the Catholic Church certainly can’t change things overnight on its own. Still, the Vatican and Pope Francis have shown themselves highly capable of impacting domestic and international health policy in the past — Catholics were crucial players on bothsides of the debate over the ACA, for instance. More importantly, with more than more than 5,000 Catholic-owned hospitals and 18,000 health dispensaries spread across the globe, the Church is as well positioned as anyone to address health issues on an international scale.

When doctors choose birth control, they make different choices than most American women. Women’s health providers are more than three times as likely to select a long-acting reversible contraceptive — like an IUD or an implant — than the general population, according to a new study in the journal Contraception.

IUDs have been steadily rising in popularity among the American public, according to data from the Centers for Disease Control and Prevention (CDC). While fewer than two percent of reproductive-aged women opted for long-acting contraceptives back in 2002, that rate has been on the uptick ever since. Over the past five years, Planned Parenthood clinics have seen a 91 percent increase in the use of IUDs and implants among their patients. Now, among the U.S. women who rely on some type of birth control, about 12 percent are using IUDs and implants.

But family planning experts have been even quicker to adopt this method of birth control. The new study, which was conducted by researchers affiliated with Planned Parenthood, found that 42 percent of the women’s health care providers who are using a birth control method opt for a long-acting reversible contraceptive.

“The difference in contraceptive choices between providers and the general population is even higher than we expected,” Dr. Ashlesha Patel, the study’s lead researcher, said in a statement. “This study shows that when it comes to their personal health care decisions, women’s health care providers are three and a half times more likely to choose IUDs and implants.”

Despite the positive benefits of IUDs, it’s taken some time to slowly shift Americans toward using long-acting birth control. That’s partly because, when IUDs were first developed, there were concerns about the method’s safety. Some people harbor lingering doubts about whether the modern version of the birth control may have the same issues, even though recent research confirmsotherwise. Across the medical field, doctors also need more training about how to talk to their patients about this method; recent studies confirm that pediatricians don’t know enough about IUDs.

Some of the stigma surrounding this particular contraceptive method has lessened as American women have started talking more about their own IUDs. This birth control inspires a type of cult following that leads users to evangelize about the benefits of their method of choice. Supporters have live-tweeted and blogged their experiences getting IUDs inserted, created Twitter hashtags to connect with other women who use IUDs, and even designed IUD-themed clothing and jewelry.

The Contraception study concludes that perhaps family planning doctors could take a similar — if subdued — approach to spreading the word about their own IUDs. The researchers conclude that, since doctors report higher IUD use than the general population, “providers might consider sharing these findings with patients, while maintaining patient choice and autonomy.”

New infections have dropped to one-tenth of peak levels, children have resumed their studies, and there’s no longer a curfew in place. But there’s much work left to be done to quell the spread of Ebola in Liberia and prepare the West African country for future outbreaks, Liberian President Ellen Johnson Sirleaf recently said.

During an interview with the Associated Press earlier this week, Sirleaf called on the international community to keep supporting Liberia as the country recovers from the Ebola epidemic and starts the work of strengthening its infrastructure that would allow it to take on future pandemics.

The West African head of state’s priorities include power to keep hospital equipment running, roads that allow the sick to access medical facilities, and clean water to prevent the spread of diseases. She plans to discuss these issues with President Barack Obama later this week during a visit to the White House.

“Our own limited resources have not enabled us to take them to the level where they could be in a preventive mode. And that’s the support we want,” Sirleaf said. “The great lesson in all these things, you know, whether you’re dealing with conflict or whether you’re dealing with disease, is to emphasize prevention rather than cure. It costs so much when you have to fix it.”

Since March 2014, more than 9,000 cases of Ebola have been confirmed in Liberia and more than 4,000 people have succumbed during what’s been called the largest outbreak on record since the discovery of the disease.

At the height of the epidemic, Liberian officials struggled to meet a growing demand for medical supplies — including specimen collection tubes, body bags, spray cans, and stationary gloves. Construction of a medical center in the capital city of Monrovia also stalled at one point. Amid doubts about the disease and panic among government officials, food markets shuttered and rates of Malaria soared.

By the end of last year, several countries had sent funds, medical personnel, and supplies to Liberia and other West African countries affected by Ebola, all of which eventually slowed down the rate of new infections. Scientists also reached a crucial milestone in their work to develop an Ebola vaccine, giving world leaders some hope that the end of the epidemic was in sight. In November, the Pentagon scaled back the size and number of Ebola treatment facilities and American troops in Liberia, building 10 units instead of 17. Each of the units had 50 beds — half the number President Obama initially pledged.

Centers for Disease Control and Prevention Director Tom Frieden, however, warned against letting up against the virus, stressing that epidemic could be endless: “That’s exactly the risk we face now. That Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come,” Frieden told NPR in December. “That is what I fear most.”

In March, Sirleaf and leaders of Guinea and Sierra Leone will present recovery plans before a group of partner countries and donors at a summit in Brussels. Oxfam, an international community-based organization that aims to find solutions to poverty across the world, called for a multi-million dollar post-Ebola Marshall Plan to rebuild the economy of the three countries.

While these plans show promise, income inequality and government corruption remain two important hurdles that Sirleaf and the other African head of states face in meeting their goals. Although Liberia has a growth rate of 8 percent, wealth has not trickled down to the majority of citizens, and questions linger about the manner in which the Liberian government handled relief funds.

Nonetheless, Nick Thompson, the chief executive of the Tony Blair Africa Governance Initiative, said the Liberian government’s response to the outbreak shows its potential to take on crises independently. “It’s easy to look at the crisis in a sort of traditional, paternalistic development mindset. I don’t think that’s the full story. It was the countries themselves, helping themselves. That means the sense of accountability has risen up and that creates a challenge for governments, but that’s good,” Thompson told the Guardian this week.

In order for Liberia to keep up the momentum, the country requires the presence of trained medical professionals to combat future spread of the disease. At the height of the Ebola outbreak, fewer than 170 qualified doctors lived in the country, a crucial gap that resulted in thousands of deaths and a strike among frustrated doctors and nurses in October. Before the virus struck, experts said that post-war Liberia needed to increase the number of qualified medical personnel ten-fold to provide adequate health services. But Liberian doctors around the world — including Dr. James Sirleaf, the president’s son — have shown a reluctance to return to their homeland.

Sirleaf is ultimately hoping that the international community steps up to help insulate the region against another potentially deadly outbreak of Ebola. “Now’s not the time to be complacent or to pull out or to… stop the support. Now’s the time to really intensify it so we put in those proper preventive measures to make sure there’s no recurrence,” the Liberian leader said.